The mean winds are blowing through, I think.
Last week was hell. After last week I didn't know why I was still doing this. I am getting tired.
The OR called mid-day. "We have a patient. We need a bed right away."
"We don't have a bed," I tell the OR nurse.
"Well, what are we supposed to do with this patient?"
"You're ACLS trained," I say. "I'm sure you'll figure out something."
SI was full. All 18 beds taken. We hastily arranged for one of ours to go to the floor--even though he probably shouldn't have. He was in traction and I was worried about compartment syndrome. Initially, I argued them into stepdown, but no beds were available. So he went to 5.
He was in traction, and the beds on the floor and in the ICU's are different. The overhead frame doesn't fit. So getting him from bed to bed is a little harder than normal. This takes some time.
Then the room has to be cleaned. Both in our unit and on the floor. 5 is finally ready for report, and I'm calling it when the phone rings again.
"Is that bed ready?"
"No. I'm calling report."
"When is the bed ready?"
"45 minutes."
"45 minutes!"
"Yes. We have a patient in it. A critically ill patient is in the room. Then the room has to be cleaned. It will be about 45 minutes."
I hang up. Go back to giving report to the 5 west nurse.
Our unit clerk comes over. He's short, clean, gay. A biochemist. Great clerk. Smart.
"The OR's on the phone. They say they're reporting us to the patient safety network. Do you want to talk to her?"
"Tell her to fuck off."
"I can't do that."
"which line?"
I get on the phone. She's hung up.
The doors burst open. The OR nurse comes steaming through.
"Why isn't that room ready?"
"Don't you ever threaten my clerk again. We don't have rooms instantly ready. Why can't you take care of this patient in the OR?"
"The patient is very unstable." she says.
"Then the OR is the perfect place for her."
"We need the room now!"
She starts ordering my staff around. Our staff being who they are, don't comply.
"Don't order my staff around. You're being completely inappropriate."
"What can I do to make this happen faster?"
"I still don't understand why you can't handle this in the OR. What's the big mystery?"
She said nothing. Kept her badge turned around.
Finally, the patient's out of the room, the room is cleaned by housekeeping, and it's ready. I call the OR.
45 minutes later, the patient rolls through the door.
The anesthesiologist is pushing something as she comes through.
"What are you pushing?" I ask.
"Epi." He stutters.
And then I understand. The patient is already dead. But they didn't want to handle the death in the OR.
I check for pulses. Nothing.
"No pulses."
"No," the anesthesiology resident sort of stammers, "no pulses. You won't feel any. She hasn't had any throughout surgery."
Fran, who's walked over to help, says, "I thought that was called pulseless electrical activity."
"Code! Call a code! "
Every thing happens at once. We slap pads on her, spill open the drug box--no pulse, some strange reading--a number, might mean something, might not. The dance begins. She's pale, yellow, not alive.
"Call my attending," the resident says.
The attending appears as if by magic, calls for a thoracotomy tray, opens her up, squeezes her heart in the rhythm it will not do on its own. "We need blood. I can't do this without blood"
But there's no blood ready.
"Why isn't there blood ready?" Our attending asks--he's fairly new. McGowan. I like him most of the time.
"No one told us she needed blood. We had no idea she was in this kind of shape."
Blood takes 23 agonizing minutes. I call down. Blood bank is irritated, rushed. Wiz runs for it. We start pouring it into her--but nothing. The fluid warmer breaks down in the middle of the code. At one point, Wiz will tell me later, there are 27 people in the room. I have no idea. The only thing I can see are my hands. Wiz will tell me later the code lasted 53 minutes. I feel like I'm moving through jello. Wiz will tell me that we look like kittens being drowned in a stock tank.
McGowan finally calls it.
I go with McGowan to talk to the family.
The mother twists away from me as I lead her back to the room. I try to prepare her a little for what she will see. "She looks very different.."I begin.
"Of course she looks different." Her mother says harshly. "She's dead."
I feel like a creep.
"Renal artery?" Ileana guesses. "Did they miss that?"
Wiz is strangely silent throughout all this.
McGowan wanders back in, for whatever reason. I'm sitting at the computer. Things have settled down.
Wiz scoots one of the stools in the pods over.
"Sad day." he says to both of us.
McGowan concurs, nodding his big head.
Wiz continues. "I just wanted to touch base with you--see what you thought could have gone better during the code."
"Well,"McGowan said, "we need to be able to get blood up here faster when we need it."
"You think we could have saved her if we had blood right there?" I ask.
McGowan shrugs. "Maybe."
"Well," Wiz says, his voice so polite and kind, I give him a sharp look. What's up? "It was good of you to get here so fast."
McGowan gives this strange little grimace and shrug.
"Enjoy it." Wiz says, now nasty.
What has happened? I look from one to the other. McGowan gets up and walks out of the unit.
Wiz looks at me, shakes his little fuzzy carp head.
"He was the surgeon."
I feel really stupid. Nauseated.
"She was dead when she came through the door. He just didn't want her dying technically on him. Then it's not his statistic."
That's my 1/2 hour
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